We all know the hallmarks of depression - low mood, lack of motivation and feelings of hopelessness. Most people experience these as a fleeting reaction to life's trials and tribulations. The ONUK survey carried out by the Institute for Optimum Nutrition and involving 37,000 people in Britain found that as many as one inthree people say they sometimes or frequently feel depressed and suffer from low moods.
A small proportion of people may slide into deeper depression, and cry uncontrollably, lose their appetite or have suicidal thoughts. People under this kind of pressure are more likely to go to their doctor to seek help, where they may be diagnosed with 'clinical' depression.
Whatever the degree, people in the industrialised world seem to be much more depressed than they used to be. Although it is entirely possible that depression is more readily diagnosed these days, the incidence has increased ten-fold since the 1950's and , according to research by London University and Warwick University, has doubled in young people over the past 12 years.
Unlike a physical condition such as diabetes that can be diagnosed by blood tests, depression is diagnosed by psychological tests, the most common being the Hamilton Rating Scale of Depression HRS). This lists questions about mood, guilt feelings, suicidal thoughts, insomnia, agitation, anxiety, physical problems, sex drive, and so on. Depending on your score, you will be diagnosed with either 'mild', 'moderate', or 'severe' depression.
When it comes to treating depression or any other chronic condition, nutrition is a real alternative as it is based on finding out what is actually going on in the patient's system and then sorting out any specific imbalances. That makes a lot more sense than giving millions of people precisely the same chemical regardless of what is actually wrong with them.
Counselling and psychotherapy
There is a curious contradiction at the heart of the drug-based approach to depression. The treatment is based on correcting a biochemical imbalance in the brain. So you might think a scientific approach would be to check whether depressed patients actually has an imbalance and if so, exactly which neurotransmitters were low so they could be given a boost. But that is not what happens. Instead, the diagnosis of depression is based solely on a checklist of psychological symptoms, which doesn't tell you anything about what is going on with the brain or indeed body chemistry.
Prozac and other anti-depressants.
Probably the biggest non-nutritional factor in recovering from depression is having someone to talk to about life's inevitable problems and stresses. Much depression is linked to, or triggered by, stressful life events such as death, the loss of a job, or the break-up of a relationship. Or you may have felt that your life was out of kilter and lacking in essential elements - a circle of supportive friends or relatives or good standing at work, for example - for some time, a feel that you're tipping over from the blues into a real depression.
Feeling bad about yourself and lacking someone supportive to listen to you can be a major cause of depression however good your diet might be. A problem shared is a problem halved. While good nutrition might give you more mental and emotional energy to solve your problems, it doesn't take away the underlying issues that fuel depression. For this reason, counselling and psychotherapy as well as nutritional approaches are recommended.
If you find you're depressed and go to your doctor, there's a good chance you'll be prescribed one of the anti-depressant drugs. Approximately half of those who seek help from their doctor are prescribed anti-depressants, while a quarter are referred for counselling. Psychological factors, including stress and not having someone to talk through your problems with, play a big part, as does nutrition, yet the emphasis on treatment usually veers towards pharmaceutical drugs.
Depression
How depressed are you?
- Do you feel downhearted, blue and sad?
- Do you feel worse in the morning?
- Do you have crying spells, or feel like it?
- Do you have trouble falling asleep, or sleeping through the night?
- Is your appetite poor?
- Are you losing weight without trying?
- Do you feel unattractive and unloveable?
- Do you prefer to be alone?
- Do you feel fearful?
- Are you often tired and irritable?
- Is it an effort to do things you used to do?
- Are you restless and unable to keep still?
- Do you feel hopeless about the future?
- Do you find it hard to make decisions?
- Do you feel less enjoyment from activities that once gave you pleasure?
Score 1 for each 'yes' answer. If you answered yes to:
LESS THAN 5: you are normal. You appear to be positive, optimistic and able to roll with the punches.
5 to 10: you have a mild to moderate case of the blues. Read on to see if anything in the feature can help. You might also consider seeking outside help.
MORE THAN 10: you are moderately to markedly depressed. Follow the advice here and also seek professional help.
Exercise is a key part of the new medicine model's non-drug approach. It also turns out to be as effective as taking anti-depressants. A number of studies in which people exercised for 30 to 60 minutes three to five times a week found a drop of around five points in their HRS - more than double what you'd expect from anti-depressants alone. In an Australian study published in 2005, involving 60 adults over the age of 60, half took up high intensity exercise three days a week, while the other half did low intensity exercise. Of those doing high intensity exercise, 61 per cent halved their HRS, while only 29 percent of those doing low intensity exercise halved their score.
And if you exercise in bright light, you get double dose of natural 'anti-depressant', as a number of studies using full-spectrum lighting (versus normal room lighting) have shown. Unlike normal 'yellow' lighting, sunlight is white and contains a stronger and fuller spectrum of light. Although more expensive, full-spectrum light bulbs are worth-while addition, especially if you are prone to the winter blues - known as SAD or Seasonal-Affective-Disorder.
In one study published in 2004, a third of depressed volunteers who exercised in full spectrum lighting experienced a major improvement in their depression (a 50 percent or more decrease in their HRS). Other studies from 2005 have also found a definitive improvement , even among those not specifically prone to SAD. The effect could be due to the direct effect of light on raising serotonin.
On other gadget, or lifestyle change you might want to consider to beat the blues is an ioniser. These give off negative ions, which are naturally generated by turbulent water - think waterfalls and the seaside- and are thought to be good for you, while positive ions, produced especially by electronic equipment such as computer screens, air-conditioning and TV sets, are not. In one controlled trial, depressed patients exposed to both full-spectrum lighting plus a high-intensity ioniser reported major improvements in their depression. By leaving an ioniser on overnight you might substantially improve mood.
How bad are anti-depressants' side effects?
(Source: Food is better medicine than drugs - Patrick Holford)
Anti-depressants may work, although not spectacularly, but it's the side effects that are truly depressing.
Up to a quarter of the people taking anti-depressants experience side effects - the milder of which include nausea, vomiting, malaise, dizziness, and headaches or migraines. Prozac, the original market leader and prescribed to more than 38 million people worldwide, has 45 listed side effects. And more: there is the increased risk of suicide, and also severe withdrawal problems with SSRIs. They are far from the magic bullet many believed they were in the 1990s.
In 2004, some 3.5 million people in Britain received prescriptions for anti-depressants, costing the NHS about £300 million.
One of the reasons so many people continue to take them, however, is that they can't get off them. Whether you call it 'cessation effects', 'withdrawal effects', or addiction, it's a major problem.
Most anti-depressants fall into one of three categories:
- monoamine oxidase inhibitors (MAOIs)
- Tricyclic anti-depressant (TCAs)
- Selective Serotonin Reuptake Inhibitors (SSRIs)
There is a fourth generation of antidepressants starting to replace SSRIs as their patents run out. These are known as serotonin and noradrenalin reuptake inhibitors, or SNRIs.
The model used by the drug companies to explain how anti-depressant drugs work is that depression is essentially a deficiency disease, the result of low level's of the brain's own 'feel-good' neurotransmitters - serotonin for mood and noradrenalin for motivation. Neurotransmitters are the chemical signals that allow messages to pass between brain cells; too little of one or other, so the story goes, and you feel gloomier and less enthusiastic. The action of these drugs is to increase the amount of one or more of these transmitters. This is almost certainly not all that is going on biologically in depression. It's very likely, for example, that inflammation is involved as well.
Natural alternatives.
Light, exercise , air and friends
Here's a simplified questionnaire to check your mood: